用户名: 密码: 验证码:
妊娠期高血压疾病患者血清蛋白含量和凝血功能指标的临床意义
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的探讨妊娠期高血压疾病患者血清蛋白含量和凝血功能指标的临床意义。
     方法1.分析妊娠期高血压疾病孕妇89例(妊娠期高血压19例,轻度子痫前期22例,重度子痫前期晚发型21例,早发型27例)患者的临床资料、血清总蛋白、白蛋白及球蛋白的检测结果,并与18例正常晚期妊娠进行比较。2.分析97例妊娠期高血压疾病(妊娠期高血压21例、轻度子痫前期26例、重度子痫前期早发型24例和重度子痫前期晚发型26例)患者的血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)及血浆纤维蛋白原(FIB)含量的检测结果,并与20例正常晚期妊娠进行比较。
     结果1.正常妊娠组、妊娠期高血压组,轻度子痫前期组、重度子痫前期晚发型和早发型组血清总蛋白的含量逐渐下降;早发型组与正常妊娠组、妊娠期高血压组比较均有显著性差异(P<0.001);晚发型组与正常组比较有统计学意义(P<0.05);白蛋白含量逐渐下降,早发型组、晚发型组与妊娠期高血压组比较均有显著性差异(P<0.001);早发型组球蛋白含量明显下降,与正常组比较有显著性差异(P<0.001);各组低蛋白血症的发生率逐渐增高,早发型组最高,与各组比较均有显著性差异(P<0.001)。2.重度子痫前期早发型组血小板计数明显下降,与晚发型组比较有差异(P<0.05),血小板减少症的发生率高达50%;早发型组与晚发型组比较PT和APTT值减少,但无统计学意义,而早发型组TT值最高;早发型组FIB含量下降,与晚发型组比较有统计学意义(P<0.05)。
     结论1.妊娠期高血压疾病患者的血清白蛋白水平是疾病严重程度的重要决定因素,血清白蛋白水平可作为预测子痫前期严重程度的有用的指标。2.PLT和FIB含量可作为妊娠期高血压疾病严重程度的重要指标,而PT、APTT和TT值不能反映妊娠高血压疾病的严重程度。
Objective To explor the clinical significance of serum protein levels and coagulation indexes in hypertensive disorders in pregnancy(HDP).
     Methods 1. Serum levels of total protein(TP), albumin, globumin and clinical data were analyzed in19 cases of gestational hypertension(GH),22 cases with mild pre-eclampsia(MPE),27 cases of early onset severe pre-eclampsia(EOSP),21 cases with late onset severe preeclampsia(LOSP) and 18 cases of normal late pregnancy women(NLP).2. Blood platelet count (PLT), PT, APTT, TT and fibrinogen (FIB) level were analyzed in 21 cases of gestational hypertension, (GH),26 cases with mild pre-eclampsia(MPE),24 cases of early onset severe pre-eclampsia(EOSP),26 cases with late onset severe pre-eclampsia(LOSP) and 20 cases of normal late pregnancy women(NLP).
     Results 1. Serum levels of TP were gradually decreased in NLP, GH, MPE, LOSP and EOSP groups, there were significance differences among EOSP, NLP and GH groups (P<0.001), and there were also significance differences between LOSP and NLP groups (P<0.05).Serum levels of albumin were also gradually decreased, and there were significance differences among EOSP, LOSPS and GH groups (P<0.001). Serum level of globumin was markedly decreased in EOSP group, there was significance differences between EOSP and NLP groups (P<0.001). Hypoproteinemia rates were gradually increased and there were significance differences among EOSP and other groups (P<0.001)
     2.PLT was markedly lower in EOSP group than that of LOSP group, there was significance differences(P<0.01), the rate of thrombocytopenia was 50% in EOSP group; the PT and APTT were lower in EOSP than that of LOSP group,there were no significance differences, but TT was hihger in EOSP group; the level of FIB was significantly decreased in EOSP gorup than that of LOSP group, and there was significance differences(P<0.01).
     Conclusion 1.Serum albumin levels is a significant determinant of disease severity in pregnancy related hypertension, and may be considered as a useful marker for predicting to severity of pre-eclampsia.2.PLT and level of FIB were significance decreased in EOSP group and it's a important determinant of disease severity, but the PT、APTT and TT can not reflect the severity of hypertensive disorders in pregnancy.
引文
[1]乐杰主编.妇产科学[M].北京:人民卫生出版社,2008:36、92-101
    [2]Heilmann L, Rath W, Pollow K. Hemostatic abnormalities in patients with severe preeclampsia [J].Clin Appl Thromb Hemost,2007,13(3):285-291
    [3]张群芳,吴元赭.重度妊娠期高血压合并低蛋白血症的临床分析[J].医学研究生学报,2007,20(12):1274-1276
    [4]Seong WJ, Chong GO, Hong DG, et al. Clinical significance of serum albumin level in pregnancy related hypertension[J]. J Obstet Res,2010,36(6):1167-1173
    [5]郑明阳,马晓艳,廖琪.子痫前期及子痫患者血小板膜蛋白Ibα及肝肾功能测定分析[J].中国妇幼保健,2008,23(29):4101-4103
    [6]Maher JE, Goldenberg RL, Tamura T, et al. Albumin levels in pregnancy:a hypothesis-decreased levels of albumin are related to increased levels of alpha-fetoprotein [J]. Early Hum Dev,1993,34(3):209-215
    [7]史峻梅,杨孜,陈蕾,等.重度子痫前期患者临床发病前预警信息分析[J].中华妇产科杂志,2009,44(5):337-340
    [8]Gojnic M, Petkovic M, Mostic T, et al. Plasma albumin level as an indicator of severity of preeclampsia [J]. Clin Exp Obeset Gynecol,2004,31(3):209-210
    [9]Brown MA, Buddle ML. Hypertension in pregnancy:maternal and fetal outcomes according to laboratory and clinical features [J]. Med Aust,1996,165(7):360-365
    [10]彭其才,周永生,张媛.子痫前期血清白蛋白浓度变化及临床意义[J].中国临床实用医药,2010,4(9):91-93
    [11]林青,周新.重度子痫前期与低蛋白血症的相关分析[J].实用医学杂志,2007,23(17):2732-2733
    [12]彭其才,周永生,吴玲玲.产前血清球蛋白浓度变化及临床意义[J].中国实用医药,2010,28:28-29
    [13]王玉洁.待产妇血清蛋白电泳各组分参考值范围的研究[J].医学理 论与实践,2006,19(10):1142-1143
    [14]沈波 张慧斐 许玲鸽,等.临产妇血清蛋白电泳谱分析[J].中华检验医学杂志,2002,25(5):299-301
    [15]陈文彬主编.诊断学[M].北京,人民卫生出版社,2008:358
    [16]仇杰,刘晓丽.妊娠期高血压疾病凝血功能指标的临床检测[J].中国妇幼保健,2008,23(19):2663-2664
    [17]郑媛媛,翟桂荣.子痫前期的凝血功能变化[J].北京医学,2007,29(4):238-240
    [18]Marietta M, Simoni L, Pedrazzi P, et al. Antithrombin plasma levels decreased is associated with preeclampsia worsening [J]. Int J Lab Hematol,2009,31(2):227-232
    [19]Rahim R, Nahar K, Khan IA. Pletelet count in 100 cases of pregnancy induced hypertension [J].Mymensingh Med J, 2010,19(1):5-9
    [20]Osmanagaoglu MA, Topcuoglu K, Ozeren M, et al. Coagulation inhibitors in pre-eclamptic pregnant women [J]. Arch Gynecol Obstet,2005,271(3):227-230
    [21]凌婉文,林建华,林其德,张为远.妊娠期高血压疾病凝血相关指标的变化[J].上海交通大学学报,2008,28(1):77-79
    [22]商晶,马晓艳,王虹.妊娠期高血压疾病患者血浆中纤维连接蛋白水平的研究[J].中国妇幼保健,2007,22(2):165-167
    [23]廖琪,马晓艳,王虹.妊娠期高血压疾病患者凝血指标变化的意义[J].中国实验诊断学,2006,10(12):1417-1418
    [24]李玉才.妊娠期高血压综合症45例凝血指标检测的临床意义[J]当代医学,2010,16(4):2-3
    [25]翁世湘,郭珠爱,黄玉香.妊娠期高血压疾病肝功能、血小板变及发生HELP综合症的处理[J].航空航天医药,2009,19(8):2526
    [26]丁海钢,吴瑞瑾,林俊.凝血及纤溶相关因子改变与重度子痫前期发病的关系研究[J].浙江预防医学,2010,22(6):5-8
    [27]曹霞,王莲莲,孙艳君,等.妊娠期高血压疾病患者凝血和纤溶系统指标的变化[J].临床误诊误治,2010,23(4):339-340
    [28]张丽中,刘建红,范林霄,等.妊娠期高血压综合症患者凝血功能 和血小板活化标志物的检测和临床意义[J].中国药物与临床,2010,10(9):987-99
    [29]汤荣华,柳发虎,孔丽娜.妊娠妇女凝血一抗凝与纤溶测定的临床意义[J].血栓与止血学,2004.10(1):17-18
    [30]孙进学,李丽,丁良臣.妊娠期高血压综合症患者凝血、抗凝及纤溶系统的变化及其临床意义[J].国际检验医学杂志,2009,30(5):490-496
    [31]张立军,韩玉环,韩玉植.早发性重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义[J].中国危重病急救医学,2010,22(6):371-374
    [32]宫继勇,田万林.妊娠期高血压疾病患者凝血功能及血栓前状态各指标的临床意义[J].蚌埠医学员学报,2006,31(1):80-82
    [33]杨双秀.妊娠期高血压综合症孕妇血小板及凝血指标的观察分析[J].中国实验诊断学,2008,12(10):1252-1253
    [34]陈怡,沈晓露,林晓华,等.妊娠期高血压疾病患者血小板活化标志物及凝血四项检测的临床意义[J].现代实用医学.2007,19(7):568-569
    [35]黄彬,陈茶,高玲,等.正常孕妇和产科早期DIC患者常规止凝血功能指标和分子标志物的对比[J].中山大学学报(医学科学版),2006(27):203-211
    [36]Barron WM, Heckerling P, Hibbara JU, et al. Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy [J].Obstet Gynecol.1999,94(3):364-370
    [37]王晚霞,李荣亨,王维.血液黏度影响因素的研究概况[J].中国老年学杂志,2008,28(13):1350-1352
    [38]Manten GT, Sikkema JM, Franx A, et al. Increased high moleculai weight fibrinogen in pre-eclampsia [J]. Thromb Res, 2003,111(3):143-147
    [39]Williams VK, Griffiths AB, Carbone S, et al. Fibrinogen concentration and factor Ⅷ activity in women with preeclampsia [J]. Hypertens Pregnancy,2007,26(4)415-421
    [40]Ustun Y, Engin-UstUn Y, Kamaci M. Associated of fibrinogen and C-reactive protein with severity of preeclampsia [J]. Eur J Obstet Gynicol Reprod Biol.2005,121(2):154-158
    [41]Karehed K, Wikstrom AK, Olsson AK, et al. Fibrinogen and histidin-rich glycoprotein in early onset preeclampsia [J]. Acta Obstet Gynecol Scand,2010,89(1):131-139
    [42]傅勤,林建华.正常妊娠妇女与重度子痫前期患者凝血功能的研究[J].现代妇产科进展,2007,16(9):657-660
    [43]卢正旺,朱慧星.产妇弥慢性血管内凝血25例凝血功能指标分析[J].实用医技杂志.2009,16(11):900-901
    [44]于戈群,阿丽娅,谷米,等.红细胞的聚集性和血浆黏度及其蛋白组分在血浆黏度调节中的作用[J].中国微循环,2004,8(5):298-300
    [45]赵野.早发性重度子痫前期的研究进展[J].吉林医学,2010,31(10):1427-1428
    [1]乐杰主编.妇产科学[M]第7版.北京:人民卫生出版社,2008:92-101
    [2]林其德.子痫前期与子痫的病因学研究进展.中国实用妇科与产科杂志,2006,22:3-5
    [3]王晨虹,晋丽平.妊娠高血压综合征患者血浆血管性假血友病因子及内皮素水平的变化.中华妇产科杂志,2001,36:212-214
    [4]仇杰,刘晓丽.妊娠期高血压疾病凝血功能指标的临床检测.中国妇幼保健,2008,23(19):2663-2664
    [5]张奕.重度妊高征患者血小板计数和红细胞压积与母婴预后的关系.中国优生与遗传杂志,2002,10:73-74
    [6]杨小福,郦美根.子痫并发血小板减少与母婴预后的分析.实用妇产科杂志,2001,17:177
    [7]Tygart SG, Mc Royan DK, Spinnato JA, et al. Longitudinal study of platelet indices during normal pregnancy. Am J Obstet Gynecol,1986,154:883-887
    [8]王虹,张京岚.慢性肺心病急性期血栓前状态指标的临床观测.中国实用内科杂志,1999,19:286-288
    [9]Hegde UM. Immune thrombocytopenia in pregnancy and new born. Brit J Obstet Gynecol,1985,92:657
    [10]Marietta M, Simoni L, Pedrazzi P, et al. Antithrombin plasma levels decreased is associated with preeclampsia worsening. Int J Lab Hematol,2009,31 (2):227-232
    [11]Rahim R, Nahar K, Khan IA. Pletelet count in 100 cases of pregnancy induced hypertension. Mymensingh Med J,2010,19 (1):5-9
    [12]Osmanagaoglu MA, Topcuoglu K, Ozeren M, et al. Coagulation inhibitors in pre-eclamptic pregnant women. Arch Gynecol Obstet,2005,271 (3):227-230
    [13]凌婉文,林建华,林其德,张为远.妊娠期高血压疾病凝血相关指标的变化.上海交通大学学报,2008,28(1):77-79
    [14]商晶,马晓艳,王虹.妊娠期高血压疾病患者血浆中纤维连接蛋白 水平的研究.中国妇幼保健,2007,22(2):165-167
    [15]廖琪,马晓艳,王虹.妊娠期高血压疾病患者凝血指标变化的意义.中国实验诊断学,2006,10(12):1417-1418
    [16]李玉才.妊娠期高血压综合症45例凝血指标检测的临床意义.当代医学,2010,16(4):2-3
    [17]翁世湘,郭珠爱,黄玉香.妊娠期高血压疾病肝功能、血小板变化及发生HELP综合症的处理.航空航天医药,2009,19(8):25-26
    [18]丁海钢,吴瑞瑾,林俊.凝血及纤溶相关因子改变与重度子痫前期发病的关系研究.浙江预防医学,2010,22(6):5-8
    [19]Heilmann L, Rath W, Pollow K. Hemostatic abnormalities in patients with severe preeclampsia.Clin Appl Thromb Hemost, 2007,13 (3):285-291
    [20]Kenneth J. Assessment of red blood cell and coagulation laboratory data. AACN Clin Issues,2004,15:622-637
    [21]宫继勇,田万林.妊娠期高血压疾病患者凝血功能及血栓前状态各指标的临床意义.蚌埠医学员学报,2006,31(1):80-82
    [22]曹霞,王莲莲,孙艳君,等.妊娠期高血压疾病患者凝血和纤溶系统指标的变化.临床误诊误治,2010,23(4):339-340
    [23]张丽中,刘建红,范林霄,等.妊娠期高血压综合症患者凝血功能和血小板活化标志物的检测和临床意义.中国药物与临床,2010,10(9):987-99
    [24]汤荣华,柳发虎,孔丽娜.妊娠妇女凝血-抗凝与纤溶测定的临床意义.血栓与止血学,2004,10(1):17-18
    [25]孙进学,李丽,丁良臣.妊娠期高血压综合症患者凝血、抗凝及纤溶系统的变化及其临床意义.国际检验医学杂志,2009,30(5):490-496
    [26]张立军,韩玉环,韩玉植.早发性重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义.中国危重病急救医学,2010,22(6):371-374
    [27]杨双秀.妊娠期高血压综合症孕妇血小板及凝血指标的观察分析.中国实验诊断学,2008,12(10):1252-1253
    [28]陈怡,沈晓露,林晓华,等.妊娠期高血压疾病患者血小板活化标 志物及凝血四项检测的临床意义.现代实用医学.2007,19(7)568-569
    [29]黄彬,陈茶,高玲,等.正常孕妇和产科早期DIC患者常规止凝血功能指标和分子标志物的对比.中山大学学报(医学科学版).2006,(27)2:203-211
    [30]Barron WM, Heckerling P, Hibbara JU, et al. Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy. Obstet Gynecol,1999,94 (3):364-370
    [31]郭文年,张保军,修瑞霞.妊高征患者凝血及纤溶指标的变化及意义.山东医药,2004,44:50
    [32]郑媛媛,翟桂荣.子痫前期的凝血功能变化.北京医学,2007,29(4):238-240.
    [33]王晚霞,李荣亨,王维.血液黏度影响因素的研究概况.中国老年学杂志,2008,28(13):1350-1352
    [34]Manten GT, Sikkema JM, Franx A, et al. Increased high moleculai weight fibrinogen in pre-eclampsia.Thromb Res, 2003,111(3):143-147
    [35]Williams VK, Griffiths AB, Carbone S, et al. Fibrinogen concentration and factor Ⅷ activity in women with preeclampsia. Hypertens Pregnancy,2007,26 (4):415-421
    [36]Ustun Y, Engin-Ustun Y, Kamaci M. Associated of fibrinogen and C-reactive protein with severity of preeclampsia. Eur J Obstet Gynicol Reprod Biol,2005,121 (2):154-158
    [37]Karehed K, Wikstrom AK, Olsson AK, et al. Fibrinogen and histidin-rich glycoprotein in early onset preeclampsia. Acta Obstet Gynecol Scand,2010,89 (1):131-139
    [38]傅勤,林建华.正常妊娠妇女与重度子痫前期患者凝血功能的研究.现代妇产科进展,2007,16(9):657-660
    [39]李世光.影响高粘滞血症的因素及临床表现.中国社区医师,2008,4:12
    [40]于戈群,阿丽娅,谷米,等.红细胞的聚集性和血浆黏度及其蛋白组分在血浆黏度调节中的作用.中国微循环.2004,8(5):298-300
    [41]卢正旺,朱慧星.产妇弥慢性血管内凝血25例凝血功能指标分析.实用医技杂志,2009,16(11):900-901
    [42]李雅丽,苏兆娟,葛月萍.妊高征患者血小板激活功能及血液纤溶状态的变化.中华妇产科杂志,1999,34:426-427
    [43]Nolan T'Smith PR, Devoe LD. Maternal plasma D-dimer level sinnormal and complicated pregnancies. Obstet Gynecol, 1993,81:235
    [44]Verduzco RL'Gonzalez PE, Manfrini MF, et al. D-Dimer in different stages of preanancy toxemia, apilot smdy. Ginecol Obstet Mex,1998,66:77-80
    [45]胡春梅,罗君.妊高征患者凝血和纤溶系统的变化及其临床意义.实用医技杂志,2004,11:175-176.
    [46]张光.产科急症.2版.北京:中国协和医科大学出版社,1993:71-72
    [47]Herb J, Weitz JI. Thrombosis and anticoagulation. Semi Hematol,1999,36(Suppl 7):118-132
    [48]李波,郑磊,张宝瑛,等.妊娠高血压综合征患者止凝血功能变化及原因分析.实用妇产科杂志,2002,18:272-274
    [49]Verspyck E, Le Cam-Duches V, Borg JY, et al. Inherited thrombophilia and pregnancy. J Gynecol Obestet Biol Reprod, 2000,29:227-229
    [50]郑磊,王前,孙德华,等.妊高征患者血栓前状态指标的检测及其临床意义.实用妇产科杂志,2003.19:356-358

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700